VA cites slow-rolled 'ao' report to oppose spina bifida bill
More than two years ago, in March 2016, the Department of Veterans Affairs received the latest in a series of scientific literature reviews from the National Academy of Medicine on Agent Orange-associated ailments.
This one raised the possibility that VA might add as many as four new conditions bladder cancer, hypothyroidism, Parkinson-like tremors and perhaps even hypertension to its list of 14 illnesses it presumes have been caused by exposure to herbicides the U.S. military sprayed during the Vietnam War.
The report delivered in 2016 moved bladder cancer and hypothyroidism from "inadequate or insufficient" evidence of association to herbicide exposure up to the "limited or suggestive" evidence of association. That's the same level VA previously relied upon to award Agent Orange benefits for conditions including laryngeal cancer, cancers of the lung, bronchus or trachea, prostate cancer.
Hypertension (high blood pressure), the report said, remained in the "limited or suggestive evidence" category too, where it was placed in a previous study. That's the same evidence level used to add ischemic heart disease to the Agent Orange presumptive disease list for near automatic award of benefits.
The Academy also clarified that Vietnam veterans with "Parkinson-like symptoms," but without a formal diagnosis of Parkinson disease, should be considered eligible for presumption of exposure to Agent Orange, just as Parkinson's disease previously was connected to service in Vietnam.
At the same time, the birth defect spina bifida in the offspring of Vietnam veterans was demoted by the Academy since its last report, from the "limited or suggestive" association category down to "inadequate or insufficient."
The Academy, previously called the Institute of Medicine, delivered this last report, Veterans and Agent Orange: Update 2014, after a panel of scientific experts spent two years reviewing the latest medical literature on health effects of dioxin and other harmful compounds in herbicides associated with certain diseases.
VA officials promised to review the results and that then-VA Secretary Bob McDonald would act on the Academy report's findings by July of 2016. With this report, however, the secretary faced no timeline for reaching a decision. That's because Congress had allowed a statutory 180-day deadline governing secretarial actions on Agent Orange scientific reviews to expire in 2015.
The consequence has been that the Obama administration in its final year did nothing more than study the report. The same has been true with the Trump administration during its first 19 months. While Vietnam veterans with, for example, bladder cancer await a decision on whether they will gain VA health care and compensation, VA has been silent on the 2016 Academy findings.
That changed slightly on Aug. 1. During a hearing of the Senate Veterans Affairs Committee dominated by discussion of the House-passed Blue Water Navy Vietnam Veterans Act (HR 299), VA Under Secretary for Benefits Paul R. Lawrence and VA's chief consultant on post-deployment health, Dr. Ralph Erickson,referred to the latest Academy report on Agent Orange.They did so not to propose that a disease be added to VA's list of conditions presumed caused by Agent Orange.
Instead they cited the report to urge senators to reject a House amendment to HR 299 that would extend Agent Orange benefits to certain Vietnam-era veterans who served in Thailand and had children born with spina bifida.
In his written testimony, Lawrence said VA "is concerned there is continued scientific uncertainty surrounding the association of spina bifida and exposure to Agent Orange. As found in the last relevant [Academy] report, an association between spina bifida and exposure to Agent Orange is no longer shown."
Erickson reinforced the point with Sen. John Boozman (R-Ark.), after the senator said he was glad to see the House bill included a bill he had co-sponsored to provide Agent Orange benefits "to any child of a veteran with covered service in Thailand who is affected by spina bifida." If the Senate passed an identical bill, said Boozman, children of Thailand-service veterans would get "the same health care, monetary allowance and vocational training" given children of Vietnam veterans with spina bifida.
"Are you all for or against that provision," Boozman asked.
Erickson noted that the Academy in 2016 "actually downgraded the evidence for there being an association of spina bifida and the children of Vietnam veterans. That doesn't mean VA withdrew that benefit. However, at the present time, extending the benefit further is a little tricky because the scientific foundation per the National Academy of Medicine has diminished remarkably."
Following the hearing we asked if VA officials weren't using the Academy report selectively now – ignoring it as a justification to add ailments to the Agent Orange presumptive list but citing it to try to block benefits to more veterans with children born with spina bifida. The department challenged that view.
"Citing a specific scientific report to discuss pending legislation (HR 299) is nothing other than a reasonable and relevant way to address specific legislative provisions under consideration," said Curt Cashour, VA press secretary.
"The issue of additional Agent Orange presumptive conditions is completely separate from HR 299, and the notion that the two issues must always be discussed together is contrary to what VA and the Senate committee were specifically examining at the August 1 hearing," Cashour added.
Carlos Fuentes, director of national legislation for Veterans of Foreign Wars, said the Academy's downgrade of evidence associated with spina bifida means more research is needed. That's why VFW "has pushed for passage of the Toxic Exposure Research Act to require the [Academy] to evaluate what research is needed to determine whether descendants of exposed veterans are impacted," he said.
Meanwhile VFW is urging the VA secretary"to make a decision as soon as possible" on the other conditions reviewed in the last Academy report.
Those decisions now pass to Robert Wilkie, the new VA secretary. We asked VA when Wilkie plans to announce decisions on these other ailments.
"We have no announcements on Agent Orange presumptive conditions at this time," said spokesman Cashour.
After then-Secretary McDonald opted to leave those decisions for the Trump administration, Dr. David Shulkin became the new president's first VA Secretary. Shulkin had served as McDonald's top health official during that period when teams of experts at VA spent months reviewing the Academy's last report.
By summer of 2017, Shulkin had promised a decision on adding new ailments to the presumptive list by Nov. 1. He later told the Senate Veterans Affairs Committee he had delivered his recommendations by that date to the White House's Office of Management and Budget. But OMB had "asked for some additional data to be able to…get financial estimates for this. So, we are committed…to get this resolved in the very near future," Shulkin said.
Shulkin was fired in March this year before revealing which conditions, if any, he wanted added to the presumptive list. The fact that his recommendations had costs that the OMB needed to assess suggests Shulkin wanted at least one more ailment to qualify for Agent Orange benefits.